Provider Demographics
NPI:1306645247
Name:NYASULU, MWAI KATE
Entity type:Individual
Prefix:
First Name:MWAI
Middle Name:KATE
Last Name:NYASULU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26007 132ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3503
Mailing Address - Country:US
Mailing Address - Phone:206-816-9207
Mailing Address - Fax:253-479-2430
Practice Address - Street 1:26007 132ND AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-3503
Practice Address - Country:US
Practice Address - Phone:206-816-9207
Practice Address - Fax:253-479-2430
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757578376G00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376G00000XNursing Service Related ProvidersNursing Home Administrator